National Center for Primary Care Morehouse School of Medicine . The Integration of Behavioral Health and Primary Care. George Rust, MD, MPH, FAAFP, FACPM Father of Dan & Christina, Husband of Cindy, Professor of Family Medicine and Director, National Center for Primary Care .
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Morehouse School of MedicineThe Integration of Behavioral Health and Primary Care
George Rust, MD, MPH, FAAFP, FACPMFather of Dan & Christina, Husband of Cindy,Professor of Family Medicine and Director, National Center for Primary Care
Promoting Excellence in Community-Oriented Primary Health Care and Optimal Health Outcomes for all Americans
Institute of Medicine, 1996
Personalismo y ConfianzaTrump Evidence-Based Medical Advice
-- Yogi Berra
Federal Partners Senior Workgroup
Satcher Health Leadership Institute
National Center for Primary Care
Rollins School of Public Health
Southeast Regional Clinicians’ Network
All Behavioral Health -- Mental Illness, Suicide, Alcohol, & Drug Use = 21.6%
Murray CJL, Lopez AD, eds. The global burden of disease and injury series, volume 1: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: World Health Organization and the World Bank, Harvard University Press, 1996. www.who.int/msa/mnh/ems/dalys/intro.htm
Rowe MG. Correlates of Depression in Primary Care. Journal of Family Practice, 1995.
18% Prevalence of Alcohol Abuse or Dependence in Primary Care
McQuade et al; Detecting symptoms of alcohol abuse in primary care. Archives of Family Medicine, 2000.
Readiness to Change in Primary Care Patients Who Screened Positive for Alcohol MisuseWilliams et al. Ann Fam Med 2006;4:213-220.
Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse. CASA- National Center on Addiction & Substance Abuse at Columbia University, April 2000.
* 21 ER Visits * 139 hospital bed-days
You are now entering . . .
Achieve Adequate Pain Control
Prevent Prescription Drug Addiction
. . . the No-Win Zone!
Preventive Services = 7.4 hrs / day
Chronic Dz (well-controlled panel) = 3.5 hrs/day
Chronic Dz (poorly-controlled panel) = 10.6 hrs/day
Østbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005 May-Jun;3(3):209-14.
Beck Anxiety Inventory
HITS (domestic violence)
Epworth Sleepiness Scale
BUT, . . . the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening adolescents, adults, and pregnant women for illicit drug use.
Whitlock EP, Green CA, Polen MR, Berg A, Klein J, Siu A, Orleans CT. Behavioral Counseling Interventions in Primary Care to Reduce Risky/Harmful Alcohol Use. Rockville (MD): Agency for Healthcare Research and Quality (US); 2004 Mar.
Friedmann PD, Zhang Z, Hendrickson J, Stein MD, Gerstein DR. Effect of primary medical care on addiction and medical severity in substance abuse treatment programs. J Gen Intern Med. 2003 Jan;18(1):1-8.
Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y. Integrating primary medical care with addiction treatment: a randomized controlled trial. JAMA. 2001 Oct 10;286(14):1715-23.
Mental Health / Substance Use Complexity
An Issue Brief on Lessons Learned and Challenges Ahead
Integration of Mental Health, Substance Abuse, & Primary Care; AHRQ, 2008.http://www.ahrq.gov/downloads/pub/evidence/pdf/mhsapc/mhsapc.pdf
Over 200 paid staff and 500 volunteers provide services at over 15 facilities to over 19,000 clients, with the vast majority served by the substance abuse programs.
“Haight Ashbury’s vision of integrated care follows an “any door is the right door” philosophy. The integrated care clinic on Mission Street provides primary care, substance abuse treatment services, mental health services, and intensive case management (which can include referrals to other organizations for assistance with housing, food, clothing, and employment) within a unified team service delivery model.” -- AHRQ Evidence Report
Psychologists & Behavioral Health
What would happen if all the health professionals came together and created a therapeutic community of healers for whole people?
Substance Abuse Treatment
Substance Abuse Treatment
-- H.E. Luccock
“We are all as angels, with only one wing;
We can only fly when we embrace each other.
-- Luciano de Crescenzo